LAUSR

A 32-year-old woman with swelling over left gluteal region and posterior aspect of both legs was referred from the dermatology OPD with clinical diagnosis of erythema nodosum. The swellings were noted 3 months back and gradually increased in size. She also gave history of weakness since last 5 months. On examination, the gluteal swelling measured 4 × 3 × 2 cm; right and left leg swellings measured 3 × 3 × 1 cm and 4 × 3 × 1 cm, respectively [Figure 1a]. They were subcutaneous with ill-defined margins and firm to feel. The overlying skin was discolored; there was no history of trauma. Fine-needle aspiration cytology (FNAC) was performed from all three lesions and revealed similar findings. The smears were cellular and showed sheets of immature granulocytic precursors with occasional myeloblasts [Figure 1b]. Based on the cytology findings, a diagnosis of multiple soft tissue chloromas was rendered and patient was reviewed. She was found to have massive splenomegaly. Hemogram revealed an elevated total leucocyte count (TLC) of 2.5 × 105/μl, hemoglobin of 8.2 g/dl, and platelet count of 80 × 103/μl. The peripheral smear showed prominent myeloid bulge with increase in granulocytic precurors and 5% myeloblasts in differential count. A final diagnosis of chronic myeloid leukemia in chronic phase (CML-CP) was given. Bone marrow performed confirmed the diagnosis. The tumor was found to be positive for BCR-ABL1 (p210) by RT-PCR. She was put on imatinib mesylate (400 mg/day). Four months posttreatment, resolution of skin lesions and normalization of TLC (6400/ μl) was noted.